Hyponatremia causes: Difference between revisions
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Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis), Osmotic diuresis, diuretic use | Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis), Osmotic diuresis, diuretic use | ||
* '''Third spacing of fluids :''' Pancreatitis, hypoalbuminemia, Small bowel obstruction | * '''Third spacing of fluids :''' Pancreatitis, hypoalbuminemia, Small bowel obstruction | ||
* '''Cerebral salt-wasting syndrome :''' Stroke ,SAH (urinary salt wasting, brain natriuretic peptide ↑) | * '''Cerebral salt-wasting syndrome :''' Stroke ,SAH (urinary salt wasting, brain natriuretic peptide ↑ causes | ||
* renal sodium loss) | |||
* '''Mineralocorticoid deficiency:''' Addison disease (primary), pituitary failure (secondary), hypothalamic failure (tertiary) | * '''Mineralocorticoid deficiency:''' Addison disease (primary), pituitary failure (secondary), hypothalamic failure (tertiary) | ||
* '''Excessive diuretic administration''' | * '''Excessive diuretic administration''' |
Revision as of 21:49, 7 May 2018
Hyponatremia Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Hyponatremia causes On the Web |
American Roentgen Ray Society Images of Hyponatremia causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saeedeh Kowsarnia M.D.[2]
Overview
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] incl ude [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
Causes
Common Causes
Diagnostic criteria of SIADH/SIAD |
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|
† Mmol and Meq are the same for univalent ions like sodium
- Causes of acute hyponatremia
Post operative phase
Polydipsia Exercise Oxyctocin Cyclophosphamide Ecstasy( 3,4-Methylenedioxymethamphetamine, MDMA) Thiazide |
( Etiologies cause hyperacute and acute hyponatremia are applicable to each category interchangeably depending on the onset of symptoms)
- Causes of Hyponatremia based upon Serum Osmolality:
Classification | Serum Osmolality | Etiology |
---|---|---|
Hypertonic or Isotonic Hyponatremia | > 295 mOsm/kg | Hyperglycemia‡, Mannitol, Glycine, Maltose |
Isotonic Hyponatremia
(Pseudohyponatremia) |
275 – 295 mOsm/kg | Lab/blood draw error, Post TURP (bladder irrigation with osmotic solutions),
intravenous immunoglobulin (IVIg), Hyperlipidemia( triglyceride, cholesterol ), Hyper paraproteinemia (monoclonal gammopathy of undetermined significance (MGUS), Multiple Myeloma), |
Hypotonic Hyponatremia | < 275 mOsm/kg | Glycerol, Sorbitol, Etiology depends upon volume status (Hypervolemic/ Euvolemic/ Hypovolemic) |
Alcohol, Urea, Ethylen glycol are ineffective osmoles, cause hyperosmolar isotonic serum but not hyponatremia. |
‡ Hyperglycemia causes osmotic diuresis results in a rise in serum sodium concentration, on the other hand it leads to extracellular shift of water due to osmotic gradient which causes relative hyponatremia , depends on which effect is stronger, there would be hypertonicity or hypotonicity[1].
- Causes of Hyponatremia based on volume status [2] :
Volume status | Sodium status | Causes |
---|---|---|
Hypovolemic
Hyponatremia[3] |
|
Bicarbonaturia ( Renal tubular acidosis, Metabolic alkalosis), Osmotic diuresis, diuretic use
|
Hypervolemic
Hyponatremia |
|
(due to relatively higher water versus salt intake and poor excretion),Nephrotic syndrome
|
Euvolemic
Hyponatremia |
|
postoperative nausea, pain,stress,Neoplasia (common), trauma, pregnancy
(caused by a low intake of solutes with relatively high fluid intake)
|
† Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
Characteristics | Hypervolemic
Hyponatremia |
Euvolemic
Hyponatremia |
Hypovolemic
Hyponatremia |
---|---|---|---|
Total body water | ↑↑ | ↑ | ↔ |
Serum sodium level | ↑ | ↔ | ↓↓ |
Plasma Osmolality, mOsm/kg | < 280 | <280 | ≥ 280 |
Urine Osmolality, mOsm/L | > 100 | > 100 | > 500 |
Urine sodium level, mEq/L | < 20 or >20 | > 20 | < 10 or > 20 |
Differentiation of causes | >20 mEq/L urinary sodium:
<20 mEq/L urinary sodium:
|
|
<10 mEq/L urinary sodium:
>20 mEq/L urinary sodium:
metabolic alkalosis)
|
- Drugs [4] cause hyponatremia:
Drug Mechanisms | Drug Classification |
---|---|
Increase ADH secretion | Antidepressants:Tricyclic antidepressants ( Amitryptiline,
Protriptyline, Desipramine),Selective serotonin reuptake inhibitors, Monoamine oxidase inhibitors Antipsychotic drugs: Phenothiazines (Thioridazine, Trifluoperazine), Butyrophenones (Haloperidol) Antiepileptic drugs: Carbamazepine, Oxcarbazepine, Sodium valproate Anticancer agents: Vinca alkaloids (Vincristine, Vinblastine), Platinum compounds (Cisplatin, Carboplatin) Alkylating agents: Intravenous, Cyclophosphamide, Melphalan, Ifosfamide Miscellaneous: Methotrexate, Interferon, Levamisole, Pentostatin, Monoclonal antibodies, MDMA, Nicotine Opiates |
Increase ADH effect | Antiepileptic drugs: Carbamazepine, Lamotrigine
Antidiabetic drugs: Chlorpropamide, Tolbutamide Anticancer agents: Alkylating agents (Intravenous cyclophosphamide) NSAIDS |
Drugs affecting water and sodium homeostasis | Diuretics:Thiazides, Indapamide, Amiloride, Loop diuretics |
Reset omostat ‡ | Antidepressants: Venlafaxine
Antiepileptic drugs:Carbamazepine |
‡ Altered sensitivity to serum osmolality by the hypothalamic osmoreceptors
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ A. I. Arieff & H. J. Carroll (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine. 51 (2): 73–94. PMID 5013637. Unknown parameter
|month=
ignored (help) - ↑ Guillaumin, Julien; DiBartola, Stephen P. (2017). "A Quick Reference on Hyponatremia". Veterinary Clinics of North America: Small Animal Practice. 47 (2): 213–217. doi:10.1016/j.cvsm.2016.10.003. ISSN 0195-5616.
- ↑ Rondon-Berrios, Helbert; Agaba, Emmanuel I.; Tzamaloukas, Antonios H. (2014). "Hyponatremia: pathophysiology, classification, manifestations and management". International Urology and Nephrology. 46 (11): 2153–2165. doi:10.1007/s11255-014-0839-2. ISSN 0301-1623.
- ↑ Liamis, George; Milionis, Haralampos; Elisaf, Moses (2008). "A Review of Drug-Induced Hyponatremia". American Journal of Kidney Diseases. 52 (1): 144–153. doi:10.1053/j.ajkd.2008.03.004. ISSN 0272-6386.